Program in Physical Therapy, School of Medicine, Washington University in St Louis, St Louis, Missouri (C.L.H.); Rehabilitation Institute of Chicago, Chicago, Illinois (P.W.H., A.L.L., G.B.M., G.B., and T.G.H.); Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin (B.D.S.); Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (T.G.H.); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana (T.G.H.).
J Neurol Phys Ther. 2018 Apr;42(2):94-101. doi: 10.1097/NPT.0000000000000217.
Previous data suggest that large amounts of high-intensity stepping training in variable contexts (tasks and environments) may improve locomotor function, aerobic capacity, and treadmill gait kinematics in individuals poststroke. Whether similar training strategies are tolerated and efficacious for patients with other acute-onset neurological diagnoses, such as motor incomplete spinal cord injury (iSCI), is unknown. Individuals with iSCI potentially have greater bilateral impairments. This case series evaluated the feasibility and preliminary short- and long-term efficacy of high-intensity variable stepping practice in ambulatory participants for more than 1 year post-iSCI.
Four participants with iSCI (neurological levels C5-T3) completed up to 40 one-hour sessions over 3 to 4 months. Stepping training in variable contexts was performed at up to 85% maximum predicted heart rate, with feasibility measures of patient tolerance, total steps/session, and intensity of training. Clinical measures of locomotor function, balance, peak metabolic capacity, and gait kinematics during graded treadmill assessments were performed at baseline and posttraining, with more than 1-year follow-up.
Participants completed 24 to 40 sessions over 8 to 15 weeks, averaging 2222 ± 653 steps per session, with primary adverse events of fatigue and muscle soreness. Modest improvements in locomotor capacity where observed at posttraining, with variable changes in lower extremity kinematics during treadmill walking.
High-intensity, variable stepping training was feasible and tolerated by participants with iSCI although only modest gains in gait function or quality were observed. The utility of this intervention in patients with more profound impairments may be limited.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A200).
先前的数据表明，大量高强度、变异性的踏阶训练（任务和环境）可能改善卒中后患者的运动功能、有氧能力和跑步机步态运动学。对于其他急性发作的神经诊断患者，如运动不完全性脊髓损伤（iSCI），类似的训练策略是否耐受和有效尚不清楚。iSCI 患者可能存在更大的双侧损伤。本病例系列评估了高强度变异性踏阶练习在 iSCI 后 1 年以上的步行参与者中的可行性以及短期和长期疗效。
4 例 iSCI 患者（神经节段 C5-T3）在 3 至 4 个月内完成了多达 40 个 1 小时的训练课程。在变异性环境中进行踏阶训练，达到最大预测心率的 85%，评估指标包括患者耐受性、总步数/疗程和训练强度。在跑步机分级评估中进行运动功能、平衡、最大代谢能力和步态运动学的临床评估，在训练前后进行，随访时间超过 1 年。
参与者在 8 至 15 周内完成了 24 至 40 个疗程，平均每个疗程 2222±653 步，主要不良事件为疲劳和肌肉酸痛。在训练后观察到运动能力的适度改善，在跑步机行走时下肢运动学有不同的变化。
高强度、变异性踏阶训练对 iSCI 患者是可行且可耐受的，尽管仅观察到步态功能或质量的适度改善。对于更严重损伤的患者，这种干预的效果可能有限。作者的更多见解视频摘要（请观看视频，补充数字内容 1，http://links.lww.com/JNPT/A200）。
